Diabetes Remission and Relapse After Bariatric Surgery: a Nationwide Population-Based Study
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Diabetes Remission and Relapse After Bariatric Surgery: a Nationwide Population-Based Study C. Conte 1,2,3 & M. Lapeyre-Mestre 1,2,3 & H. Hanaire 4 & P. Ritz 3,5 Received: 14 February 2020 / Revised: 10 August 2020 / Accepted: 11 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The long-term impact of bariatric surgery on the remission of type 2 diabetes (T2DM) remains to be clarified through large nationally representative cohorts. The objectives were to determine the incidence of T2DM remission and relapse after bariatric surgery, to determine the factors associated with remission and to establish a profile for patients at risk for relapse. Materials and Methods We conducted a population-based cohort study using data from the French national health insurance database (Systeme national des données de santé [SNDS]). We had access to exhaustive regional data between 2013 and 2017 and to a national representative sample of the French population (EGB) from 2008 to 2018. Patients were included if they were adults and diabetics with incidental bariatric surgery. Results This study shows that 50% of patients are in remission from diabetes after bariatric surgery within a median of 2 to 4 months. Diabetes relapse was observed in 13–20% within 10 years. The factors favouring remission already described were noted (non-insulin-dependent diabetes) and original factors were also identified, in particular the advantage of bypass surgery over sleeve gastrectomy, with more remissions and fewer relapses. Conclusion This study highlights a 50% prevalence of remission and a low prevalence of relapse. There are non-modifiable risk factors for remission and relapse (characteristics of diabetes, age, lipid-lowering therapy) and modifiable factors (type of surgery). Identifying these factors is essential for optimal management of patients. Additional data are essential to confirm the results of our analysis of the factors associated with relapse. Keywords Obesity . Bariatric surgery . Diabetes . French national health insurance database (Systeme national des données de santé [SNDS])
Introduction Bariatric surgery is the most effective method of weight loss in severe obesity as it improves the quality of life and comorbidities of obesity [1]. The remission of type 2 diabetes (T2DM) after surgery occurs in 70% of the people
* P. Ritz [email protected] 1
Clinical Pharmacology Department, Toulouse University Hospital, Toulouse, France
2
Clinical Investigation Center (CIC 1436), INSERM and Toulouse University Hospital, Toulouse, France
3
Inserm unit 1027, University of Toulouse 3, Toulouse, France
4
Diabetes Department, Toulouse CIO (Obesity Medicine Reference Center) and CHU (University Hospital), Toulouse, France
5
Nutrition Department, Toulouse CIO and CHU, Toulouse, France
who have had surgery [2, 3]. The factors of remission identified are the preservation of insulin secretion and significant initial weight loss [4], which favours remission, whi
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